Mr E (52) and his wife, Mrs E (38) arrive at their GP very concerned. When they engaged in sexual activity the night before, Mr E noticed blood in his semen when he ejaculated. At first Mr E thought that his wife was menstruating, but when she reminded him that she’s on a three-month birth control injection (Depo-Provera), he became very concerned.
The following are highlights from the doctor’s history taking:
1. Mr E has no erectile difficulties.
2. He’s had no previous surgeries.
3. This is his first episode of this nature.
4. He does not have any difficulty passing urine.
5. The only other complaint he has is a sore throat that he’s had for a while.
6. Mr E works as a marketing agent and regularly travels to Johannesburg for up to two weeks at a time.
On examination the doctor found the following:
1. Slightly swollen glands in Mr E’s neck and groin
2. No abnormalities on abdominal examination
3. Prostate slightly enlarged, but not tender and no individual masses
4. Slightly tender right testicle
5. Very red penis tip and entry to the urethra (opening on penis head)
The GP decided to start with basic investigations. On one of the side-room investigations, he found a possible cause for the problem.
In this case there is more than one possible cause, but one in particular stands out.
Clue: maybe the GP should ask Mrs E some questions too . . .
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Previously on What's Your Diagnosis
What's your diagnosis? - Case 1: vomiting and weight loss
What's your diagnosis? - Case 2: eye pain
What's your diagnosis? - Case 3: strange behaviour and a bullet in the back
What's your diagnosis? - Case 4: seeing odd things
What's your diagnosis? - Case 5: mysterious lungs
What's your diagnosis? - Case 6: runner with seizures
What's your diagnosis? - Case 7: swollen knee